Treatment Guideline Chart
Dermatophytoses are superficial fungal infections that have different presentations and are named based on location.
Tinea corporis (ringworm) usually presents with lesions of varying sizes, degree of inflammation and depth of involvement found on the trunk, extremities or face excluding the beard area in men.
Tinea cruris (jock itch) are lesions found on the groin. It may affect the proximal medial thighs and extend to the buttocks and abdomen. The scrotum and penis tend to be unaffected.
The red scaling lesions with raised borders have pustules and vesicles at the active edge of infected area.
Tinea pedis (athlete's foot) are lesions found in the interdigital spaces (most common), sole of foot, and sides of feet.

Tinea%20corporis,%20cruris%20-and-%20pedis Treatment

Principles of Therapy

Topical Antifungals

  • Most tinea corporis, cruris and pedis infections can be treated topically
  • Choice of agent will depend on cost, physician and patient preference
    • There are few direct comparison studies between agents of different groups; it is difficult to justify choice of one agent over another
  • For tinea pedis, treatment is targeted towards control of symptoms and spread to other parts of the body
    • Topical therapy is the preferred route of treatment

Topical Corticosteroids

  • Should only be used in combination with antifungal and limited only to confirmed fungal infections in patients suffering from symptomatic inflammation, itching, erythema and burning sensation
    • Should be used only in the first few days of treatment
  • Effects: There is usually rapid symptomatic relief
  • Use with caution when treating areas of thin skin and naturally occluded body areas (eg groin, axillae, breast and face)
  • Combination topical corticosteroids with antifungal should not be administered in children <12 years
  • Topical antifungals combined with corticosteroids are available. Please see prescribing information for specific formulations in the latest MIMS.


Topical Antifungals


  • Eg Naftifine, Terbinafine
  • Actions: Fungicidal in vitro
  • Effects: Allylamines may produce a faster response and slightly more effective than azoles
  • Naftifine has anti-inflammatory properties


  • Eg Clotrimazole, Bifonazole, Eberconazole, Econazole, Efinaconazole, Fluconazole, Itraconazole, Ketoconazole, Luliconazole, Miconazole, Oxiconazole, Sertaconazole, Sulconazole 
  • Many imidazoles and triazoles are available and these agents have broad-spectrum activity
  • Actions: Bind to phospholipids in the fungal cell wall membrane resulting in loss of essential intracellular elements, fungistatic in vitro
  • Effects: Typically result in cure when treating tinea infections
  • Sertaconazole and Luliconazole possess potent anti-inflammatory effects comparable to antifungal-corticosteroid combinations
  • Efinaconazole is a treatment option for patients with co-existing tinea unguium infection


  • Butenafine is similar in structure to the allylamines
  • Actions: Fungicidal in vitro
  • Effects: Has high cure rates and long disease-free intervals in treating interdigital tinea pedis


  • Amorolfine
    • Alternative treatment option for patients with tinea pedis
    • Effects: Active against dermatophytes, dimorphic fungi, yeasts, other filamentous and dematiaceous fungi
  • Amphotericin B
    • Treatment option for various mucocutaneous fungal infections including dermatophytosis, with minimal adverse events seen
    • Effects: Has broad-spectrum antifungal activity against most pathogenic fungi
  • Ciclopirox
    • Effects: Has broad-spectrum coverage against dermatophytes, yeasts and some bacteria
  • Haloprogin
    • Effects: Has equivalent efficacy with Tolnaftate but has a broader fungal spectrum including yeasts
  • Tolnaftate
    • Effects: Effective in most dermatophytoses and tinea versicolor but has narrow-spectrum antifungal activity; no antibacterial or anti-candidal activity

Optimal Vehicles of Topical Treatment


  • Recommended for non-oozing and moderately scaling lesions


  • Easily spread on hairy areas
  • Recommended for intertriginous areas or oozing lesions


  • Useful for hyperkeratotic lesions

Powders and Sprays

  • May be used to prevent reinfection; should be applied to the feet rather than to the shoes
    • Typically not very effective in treating active infection

Oral Antifungals

  • Eg Fluconazole, Griseofulvin, Itraconazole, Terbinafine 
  • May be considered in patients with extensive disease, unresponsive to treatments, immunocompromised, or severe moccasin-type tinea of the plantar surface 
    • Recommended dose of oral Terbinafine has been shown to produce sustained cure rates of 71-94%
    • Griseofulvin use resulted in a 27-35% cure rate 
  • Oral antifungals have been used to control acute vesicular tinea pedis
    • Pulse doses of Fluconazole, Itraconazole and Terbinafine have been shown effective
    • Use of Fluconazole in immunocompromised patients should be done sparingly
    • Observe caution in patients being treated with CYP3A4 substrates, HMG-CoA reductase inhibitors, and anticoagulants
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